amitriptyline hydrochloride Nursing Considerations & Management

Drug Name

Dosage & route

May be given IM if patients are unable or unwilling to take oral drug. Switch to oral drug as soon as possible.

ADULTS

Depression, hospitalized patients: Initially, 100 mg/day PO in divided doses: gradually increase to 200–300 mg/day as required. May be given IM 20–30 mg qid, initially only in patients unable or unwilling to take drug PO. Replace with oral medication as soon as possible.

Depression, outpatients: Initially, 75 mg/day PO, in divided doses; may increase to 150 mg/day. Increases should be made in late afternoon or at bedtime. Total daily dosage may be administered at bedtime. Initiate single daily dose therapy with 50–100 mg at bedtime; increase by 25–50 mg as necessary to a total of 150 mg/day. Maintenance dose is 40–100 mg/day, which may be given as a single bedtime dose. After satisfactory response, reduce to lowest effective dosage. Continue therapy for 3 mo or longer to lessen possibility of relapse.

Therapeutic actions

Mechanism of action unknown; TCAs inhibit the reuptake of the neurotransmitters norepinephrine and serotonin, leading to an increase in their effects; anticholinergic at CNS and peripheral receptors; sedative.

Indications

Relief of symptoms of depression (endogenous most responsive); sedative effects may help when depression is associated with anxiety and sleep disturbance.